HEROs: New Mexico's Health Extension as a Model for Primary Care Transformation through Collaboration and Shared Resources Project Summary/Abstract Outlined in this proposal is the response from a growing network of organizations in New Mexico, collaborating as a shared resource in the transformation of small to medium sized primary care practices to patient-centered medical homes (PCMHs). The transformation model created in New Mexico to address barriers for resource- poor, understaffed small practices is Health Extension Rural Offices (HEROs), which is a community-based, University-linked model that can be adapted in other states and nationally. The model enhancements described in this proposal will add an array of practice improvement strategies and further support existing efforts and the expansion of the HEROs model will lead to accomplishing the following five specific aims: " Health Extension as a Catalyst for Primary Care Practice Transformation " HEROs Staff as Primary Care Practice Transformation Coaches " Adoption of Quality Improvement Models and Strategies by Primary Care Practices " A Scalable Model for a National Primary Care Extension Service " Evaluation and Dissemination of the Primary Care Extension Model To achieve these aims, staff of five, regional Health Extension Rural Offices (HEROs) affiliated with the University of New Mexico Health Sciences Center (UNM HSC) will provide technical assistance, offering a menu of shared resources to help practices make incremental transformation toward a PCMH over the two year grant period. A Core Team representing major, statewide programs that provide primary practices with components of PCMH transformation (from Information Technology to Quality Improvement to Telehealth) will support the work of the HEROs staff. This grant will facilitate an unprecedented sharing of resources between these programs to accelerate PCMH transformation. A robust evaluation plan will track the effectiveness of the transformation process in quantitative and qualitative dimensions. Data collection instrument and measures include Organizational Readiness for Change, NCQA Patient-Centered Medical Home Checklist, Practice Coaching Effectiveness Dashboard, HERO Activities Log, Adequacy of Data Management Plan, and a Data Analysis Plan. A comprehensive dissemination will feature a Primary Care Health Extension Toolkit, jointly developed by the New Mexico Core Team with its dissemination partners in three other states (Kansas, Kentucky and Oregon) for web-based dissemination. The HEROs program will be scaled up nationally and sustained in-state with all ~100 independent, small primary care practices in New Mexico achieving PCMH status by year five. PUBLIC HEALTH RELEVANCE: HEROs: New Mexico's Health Extension as a Model for Primary Care Transformation through Collaboration and Shared Resources Project Narrative Primary care practice transformation to a patient-centered medical home (PCMH) is difficult for resource-poor, understaffed, small primary care practices. The fundamental strategy New Mexico will employ to address the challenges to primary care infrastructure and practice transformation is the concept of Health Extension (a program known as "HEROs"), a community-based, state-wide, but university-linked network of agents that can assist and support small and medium sized primary care practices with the best evidence-based practices to support the provision of quality care and practice transformation. Health Extension mobilizes shared resources of the academic health center, public health and other state agencies, information technology and programs to the state's rural and urban, predominantly minority, and underserved communities that depend on local primary care practices for immediate access to health care.